Martín A, Fernández-Jiménez M C, Caballero M D, Canales M A, Pérez-Simón J A, García de Bustos J, Vázquez L, Hernández-Navarro F, San Miguel J F
Servicio de Hematología, Hospital Clínico Universitario de Salamanca, Salamanca, Spain.
Br J Haematol. 2001 Apr;113(1):161-71. doi: 10.1046/j.1365-2141.2001.02714.x.
Several studies have focused on investigation of the optimal salvage regimen to induce maximum response before autologous stem cell transplantation (ASCT) in patients with relapsed or refractory Hodgkin's disease (HD). However, in most of these studies, the follow-up is relatively short. In the present study, we report on long-term results of 55 consecutive patients with HD who received Mini-BEAM [BCNU (carmustine), etoposide, cytarabine, melphalan] as salvage therapy before ASCT. Eleven patients were refractory to front-line therapy, 17 were partial responders, and 27 patients had relapsed from HD. Twenty-eight patients achieved complete response, and 18 achieved partial response with a median of two cycles of Mini-BEAM, giving a total response rate of 84%. Significant factors predicting poor response (P < 0.05) were: initial treatment with MOPP (mechloroethamine, oncovin, procarbazine, prednisolone), > or = two previous chemotherapy regimens and three disease characteristics at Mini-BEAM treatment: presence of B symptoms, extranodal involvement or low serum albumin. However, only the last two factors retained independent influence on multivariate analysis. In total, 45/55 patients have been transplanted. Median follow-up after Mini-BEAM administration for living patients is 68 months. At the time of reporting, 31 out of 55 patients (56.4%) are still alive, 21 patients (38%) have relapsed, three (5.4%) have developed secondary neoplasias, and five have died of other complications not related to disease progression. The actuarial 7-year overall survival (OS) was 52%, the progression-free survival (PFS) 54% and the event-free survival (EFS) 36%. The response to Mini-BEAM was the most important prognostic factor for predicting the long-term probability of surviving the disease: none of the eight patients who did not respond to Mini-BEAM were alive at 3 years. On multivariate analysis, response to Mini-BEAM and extranodal involvement before Mini-BEAM had a significant influence on OS. Our results show the safety and efficacy of Mini-BEAM before ASCT for refractory or relapsed HD patients.
多项研究聚焦于探究在复发或难治性霍奇金淋巴瘤（HD）患者进行自体干细胞移植（ASCT）前，能诱导最大缓解的最佳挽救方案。然而，在这些研究中的大多数，随访时间相对较短。在本研究中，我们报告了55例连续HD患者的长期结果，这些患者在ASCT前接受Mini-BEAM方案[卡莫司汀（BCNU）、依托泊苷、阿糖胞苷、美法仑]作为挽救治疗。11例患者对一线治疗耐药，17例为部分缓解者，27例患者HD复发。28例患者达到完全缓解，18例达到部分缓解，Mini-BEAM方案的中位疗程数为两个周期，总缓解率为84%。预测缓解不佳（P<0.05）的显著因素为：初始采用MOPP方案（氮芥、长春新碱、丙卡巴肼、泼尼松龙）治疗、既往化疗方案≥两种以及Mini-BEAM治疗时的三个疾病特征：存在B症状、结外受累或血清白蛋白水平低。然而，在多变量分析中，仅最后两个因素保留独立影响。总共45/55例患者接受了移植。Mini-BEAM方案给药后，存活患者的中位随访时间为68个月。在报告时，55例患者中有31例（56.4%）仍存活，21例（38%）复发，3例（5.4%）发生了第二肿瘤，5例死于与疾病进展无关的其他并发症。7年总生存率（OS）的精算值为52%，无进展生存率（PFS）为54%，无事件生存率（EFS）为36%。对Mini-BEAM方案的反应是预测长期疾病生存概率的最重要预后因素：对Mini-BEAM方案无反应的8例患者中，3年时无一例存活。在多变量分析中，对Mini-BEAM方案的反应以及Mini-BEAM治疗前的结外受累对总生存率有显著影响。我们的结果显示了Mini-BEAM方案在难治性或复发性HD患者ASCT前的安全性和有效性。
